Bridging Gaps in Cervical Cancer Care: A Web-Based Intervention to Improve Knowledge and Follow-up.

Abstract

Contributors to disparities and worse cervical cancer outcomes include limited education and loss to follow-up after an abnormal Pap smear. Effective interventions are necessary to engage diverse populations. We piloted an intervention to assess acceptability, knowledge uptake and follow-up. This prospective pilot study recruited patients scheduled for colposcopy visits at a government-insured clinic and faculty clinics within an academic medical center to use the Patient Activated Learning System (PALS). The PALS intervention included 5 short educational videos about human papillomavirus and colposcopy. Participants completed a baseline knowledge questionnaire, viewed PALS videos followed by post-intervention knowledge and acceptability surveys. Perceptions of PALS, anxiety, and impact on follow-up were evaluated. Of 63 (70%) participants completing the intervention, 24 (38%) were from the government-insured clinic and 39 (62%) from faculty clinics. Median age was 36 (range 30-48), 38 (63%) were racial and ethnic minorities, and 21 (33%) were non-Hispanic White. The intervention improved knowledge scores for the entire cohort (60%-75%, p < .01), even when stratified by race/ethnicity (p < .01 for all), income (p < .01), education (p < .01), practice (p < .01), and insurance type (p < .001). Participants found PALS convenient to use (4.6/5), enjoyable (4.2/5), and acceptable (4.6/5); 75% said the videos alleviated colposcopy-related anxiety, and 84% indicated PALS made them more likely to follow up. The guideline concordant follow-up rate among study completers was 73%. In this pilot study, PALS was effective and acceptable among a diverse cohort. These free, widely viewed videos can successfully engage diverse populations to improve colposcopy knowledge and follow-up.